Exit Canaan Community Space Community Needs Survey As Canaan moves toward the establishment of a community center in town, we want to gather data from residents and taxpayers as to what that means to you. Your feedback is valuable! Question Title * 1. About how long have you lived in Canaan 0-5 years 5-10 years 10-20 years 20-30 years 30-60 years 60+ years Other (please specify) Question Title * 2. Are you a registered voter in the town of Canaan, NH Yes No Unsure / Don’t know Question Title * 3. Do you think that the town of Canaan would benefit from a community center? Definitely would Probably would Probably would not Definitely would not Question Title * 4. What type of community center does Canaan need? Please be as specific as possible. Question Title * 5. Are you a member of any groups, organizations, or clubs in the community? Yes No Please list all groups/clubs: Question Title * 6. What do you like best about Canaan? Question Title * 7. Do you know anyone in Canaan who doesn't have the support they need? For example, a neighbor who is lonely and would like conversation, or someone who is sick and doesn't have help. Yes No Question Title * 8. Which of the following categories best describes your employment status? Employed, working full-time Employed, working part-time Not employed, looking for work Not employed, NOT looking for work Retired Disabled, not able to work Other (please specify) Question Title * 9. Which category includes your age? 18 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 to 74 75 or older Question Title * 10. How many children age 17 and younger live in the household? None 1 2 3 4 More than 4 Question Title * 11. Would you like to include your name and/or contact information? Name Address Address 2 City/Town State/Province ZIP/Postal Code Country Email Address Phone Number Done
